With new bans on smoking and disposable vapes set to take effect this year, we take a look at what dental professionals need to know about the impact of both habits on oral health.
Smoking and vaping – the key stats
Despite widespread awareness of their associated health risks, smoking and vaping are common habits in the UK. Tobacco smoking has been a public health concern for decades and is recognised as the number one preventable cause of death, disability and ill health in the UK. It also causes around 80,000 deaths a year and one in four of all cancer deaths in England.
Meanwhile, vaping is a much newer trend, having rapidly emerged as a popular alternative to smoking. It has hit younger generations particularly hard, sparking growing concerns about nicotine addiction, the long-term impact on health, and vaping products serving as a gateway to cigarettes. But despite its explosive rise in popularity, more research is needed to fully understand its impact on the human body.
Tobacco decline
In 2024, a World Health Organization (WHO) report found that tobacco use is declining across the globe. According to the report, one in five adults worldwide are consuming tobacco – a notable decline from one in three in 2000.
In addition, 150 countries are successfully reducing tobacco use, with Brazil and the Netherlands seeing the most significant declines – 35% and 30% respectively. Despite this, the report highlights that the world is not on track to meet the global goal of a 30% reduction from the 2010 baseline. Instead, it will likely achieve a 25% by the end of 2025. However, 56 countries are expected to reach the goal, though this is four less than was estimated in the 2021 WHO report.
Ruediger Krech, director of the WHO department of health promotion, said: ‘Good progress has been made in tobacco control in recent years, but there is no time for complacency. I’m astounded at the depths the tobacco industry will go to pursue profits at the expense of countless lives.
‘We see that the minute a government thinks they have won the fight against tobacco, the tobacco industry seizes the opportunity to manipulate health policies and sell their deadly products.’
Children and vaping
The WHO has recognised ‘an alarming increase in use of e-cigarettes among children and young people’. In many countries, rates exceed adult use.
The marketing of vape products has become a particular concern, with WHO warning that they are ‘aggressively marketed to young people’. It said: ‘E-cigarettes target children through social media and influencers, with at least 16 000 attractive flavours. Some of these products use cartoon characters and have sleek designs, which appeal to the younger generation.
‘Some look like toys and games. There is an alarming increase in use of e-cigarettes among children and young people, with rates exceeding adult use in many countries. Even brief exposure to e-cigarette content on social media is associated with greater intention to use these products, as well as more positive attitudes toward e-cigarettes.’
Data from NHS England also reveals that nearly one in 10 (9%) secondary school children vape regularly. This was his was a key finding of the 2023 Smoking, Drinking and Drug Use among Young People in England report, which included results from a survey of secondary school pupils in England. The report also found that regular and occasional vaping amongst children aged 11 to 15 had increased from 6% in 2018 to 9%.
In addition, UK charity Action on Smoking and Health (ASH) estimates that 230,000 children vape more than once a week. The charity said: ‘There is an indication that young vapers may be more dependent than they were four years ago, with more current vapers reporting strong urges to vape compared to 2020. This suggests that newer products may be increasing dependency, underscoring the urgency for stronger regulations.’
The University College London (UCL)study, funded by Cancer Research UK, analysed survey data from 2016-2024. The findings revealed that the number of people using both vapes and cigarettes has increased sharply from 3.5% to 5.2% – amounting to a rise from one in 30 people to one in 20. The sharpest increase took place in 2021 when e-cigarettes first became popular.
The researchers also found that the increase was greatest for young adults, with two thirds of 18- to 24-year-olds now both smoking and vaping – a significant increase from just one in five in 2016.
In addition, the study identified a notable shift in habits of dual users. Those who smoke daily but don’t vape daily have more than halved from 32% to 15%, and those who vape daily but don’t smoke daily have more than doubled from 8% to 22%. The researchers believe this may be due to the increase of young adult dual users, who are more likely to vape frequently.
Smoking and oral health
NHS England states that tobacco use seriously impacts both general and oral health. The most significant effects of tobacco use on oral health are oral cancers and precancers, increased severity and extent of periodontal diseases, tooth loss and poor wound-healing post-operatively. It can also result in stained teeth, reduced taste sensation and halitosis.
Dental therapist Zuzanna Sadura, said: ‘Smoking is one of main risk factors for periodontal disease. The disease is preventable, but not curable.
‘It causes very serious, irreversible damage to the bone. As a result of that gum recession, it creates longer looking teeth, bigger gaps and traps food. These are all very undesirable changes to the aesthetics of people’s smiles. This, in turn, impacts on people confidence and self-esteem.’
Increased prevalence and severity of periodontal disease. Smoking cessation can halt disease progression and improve the outcome of periodontal treatment
Dental implant failure. Rates are significantly higher in smokers than in non-smokers
Oral cancer and precancer occurs much more frequently in smokers than in non-smokers. Smoking cessation significantly decreases the increased risk of oral cancer within five to 10 years.
Oral cancer
Smoking is the leading preventable cause of death, disability and poor health in the UK. It contributes to around 80,000 deaths per year and one in four cancer-related deaths in England.
Most alarmingly, it is also the biggest contributor to an increased risk of oral cancer, being linked to approximately 65% of cases. Smokers are 91% more likely to develop oral cancer than non-smokers.
According to the Oral Health Foundation’s State of Mouth Cancer UK Report 2024, annual cases of mouth cancer diagnosed in the UK have risen to 10,825, up from 8,864 the previous year. This has seen an 38% increase in the past decade and 133% in the last 20 years. Last year, 3,637 people died as a result of mouth cancer.
Cases on the rise
Dr Nigel Carter, CEO of the Oral Health Foundation, says: ‘Unlike some cancers, there is a direct link between smoking and mouth cancer. Of all the lifestyle factors, smoking, can greatly increase a person’s likelihood of developing mouth cancer throughout their life.
‘A smoker’s risk of being diagnosed with mouth cancer is almost double that of a never-smoker. Like most cancers, the chances of survival are dependent on early diagnosis. Unfortunately, more than half of all cases of mouth cancer are not diagnosed until stage IV.
‘If we can encourage those who smoke to try to stop smoking and be mouth aware and visit their dentist regularly and check their tongue, gums, and throat for any changes. For patients any ulcer, red or white patch that has not healed within three weeks should be checked out by their dentist or other health care professional.’
He continues: ‘By carrying out these simple measures, we could potentially save thousands of lives. Last year, 10,825 new diagnoses surpassed the 10,000 mark for the first time.
‘This represents an increase of 133% in the last 20 years.
‘We need to raise awareness of the symptoms, the risk factors, and most importantly, the importance of early detection.’
Vaping and oral health
Richard Holliday is a senior lecturer and honorary consultant in restorative dentistry at Newcastle University. Here, he shares what studies have found about the impact of vaping on oral health.
The evidence base and general health advice regarding vaping is nicely summarised by the chief medical officer for England, Professor Sir Chris Whitty: ‘If you smoke, vaping is much safer; if you don’t smoke, don’t vape.’ This also applies to oral health. Smoking is uniquely damaging to the oral cavity. The current evidence base suggests that e-cigarette use is far less damaging but not risk free. Let’s briefly explore the evidence across a few different disease areas.
Most of the studies to date have focused on the impacts of e-cigarettes on periodontal health. Our research group recently conducted a systematic review and meta-analysis, trying to pull together all the research in this area.
We found that many of the studies were at high risk of bias – this was usually because the ‘e-cigarette users’ under investigation were also current or previous tobacco smokers (or studies had not checked for this), making it hard to pick out the effects of the e-cigarettes alone – the findings should be considered with this in mind.
‘We still don’t know the full extent of damage that can be caused from vaping or e-cigarettes’
The study generally found that the results for vapers were most similar to non-smokers/former smokers, with smokers having worse outcomes. However, an interesting finding was that vapers had lower bleeding on probing and gingival indices than non-smokers/former smokers, indicating that the suppression effects seen in smoking were also present in vaping.
We found no evidence of e-cigarette users having more markers of periodontal destruction (pocket probing depths or marginal bone loss) than non-smokers/former smokers. Further well-designed research is needed. In the UK the Enhance-D clinical trial, funded by the National Institute for Health and Care Research (NIHR), is currently ongoing and will provide important results in this area.
An area to watch
There is little evidence around vaping and dental caries. The most important study to date was a large US cross-sectional study of self-reported data which reported an association between e-cigarette use and untreated caries. With regards to possible aetiological routes, e-cigarettes don’t usually contain sugars (this would clog up the heating element), but they often lead to a dry mouth and laboratory studies have shown it can make for a ‘stickier’ plaque. This is an area to watch.
With regards to oral cancer risk, this is not currently an area of concern. The majority of the carcinogens from tobacco smoke come from the tar and the combustion process – both of which are absent from e-cigarettes. Nicotine is not a carcinogen.
Finally, dental erosion could be an area of concern if the e-cigarette aerosols were erosive. From the limited research in this field so far it appears that the inclusion of nicotine in the e-liquids makes them alkaline. Non-nicotine e-liquids are more likely to be acidic and have a potentially erosive effect. More research is required on this topic
There has been a noticeable rise in the uptake of vaping, especially within a social setting among the younger population. From a dental health perspective, we still don’t know the full extent of damage that can be caused from vaping or e-cigarettes. We are aware of the risks associated and certain symptoms patients may experience, such as dry mouth and the impact this may have on patients’ oral microbiome.
The role of dental professionals
‘It’s pivotal we can understand the risks so we can educate on the overall effect this has to a patients oral health, which they may not be aware of’
Chrystal Sharpe
Orthodontic therapist
As dental care professionals (DCPs), we are at the forefront of education as we have the unique opportunity of seeing patients on a regular basis therefore, it’s pivotal we can understand the risks so we can educate on the overall effect this has to a patients oral health, which they may not be aware of.
At the same time, it’s important to be mindful that a large percentage of vape users started vaping in order to treat a current nicotine addiction from smoking, believing that vaping was a healthier solution and a road to recovery.
We as DCPs have a duty of care to encourage patients to commit to healthier habits rather than shame them for their current vaping or smoking. We are not fully equipped to deal with addiction, as this is not within our training or scope of practice.
Patient guidance
However, we should be able to provide guidance or advice on the necessary resources available, pointing patients in the right direction to access these and make them feel empowered to do so.
A commonly applauded resource to help quit smoking is Alan Carr’s book, Alan Carr’s easy way to quit smoking. The author himself is a former smoker and his approach empathises with a smoker’s emotional attachment to the habit and understands the psychology behind how they got there. A free resource you could recommend is the Smoke Free app which collates both the health and financial benefits of quitting in real time all within one place. This is particularly great for people that require a daily reminder of the progress they are making.
From an oral hygiene stand point, we can recommend substitutes to alleviate symptoms such as the use of sugar-free xylitol gum which helps to promote healthy bacteria within the mouth. We should also advise the patient to stay hydrated and recommend regular hygiene and routine dental appointments.
Ultimately, if we build a relationship with a patient who is committed to the journey to quit smoking or vaping, we should advise them to see their local GP who will have further resources available to help support their journey.
UK smoking ban – key facts
In November 2024, MPs voted in favour of the Tobacco and Vapes Bill, bringing it one step closer to implementation.
Speaking to the House of Commons, health secretary Wes Streeting said smoking is ‘the leading cause of sickness, disability and death in our country’. He added that the legislation would help to create a smoke-free generation and ‘come down on the vaping industry like a tonne of bricks’.
Currently, the second reading of the bill is due to take place in the House of Lords. Once it completes its committee stage, report stage and third reading, it will reach the final stages of its passage, which includes formal approval by the King.
What is the Tobacco and Vapes Bill?
The Tobacco and Vapes Bill aims to reduce smoking and vaping rates, especially among younger generations, and ensure better control over the retail and promotional aspects of these products.
This will involve:
Prohibition on tobacco sales to future generations: bans the sale of tobacco to individuals born on or after 1 January 2009, effectively creating a smoke-free generation
Licensing of retail sales: establishes a system to license retailers who sell tobacco and vape products
Retailer registration: requires retailers to be registered for the sale of tobacco and vape products to ensure regulation and compliance
Control of advertising and promotion: introduces regulations to control the advertising and promotion of tobacco and vape products, including restrictions to reduce appeal to children. This involves new powers to regulate the flavours, contents and packaging of vaping products
Smoke-free, vape-free and heated tobacco-free areas: expands regulations on smoke-free places to include vape-free and heated tobacco-free areas, further protecting the public from exposure to harmful substances.
After outlining the measures included in the bill to the House of Commons, Streeting said: ‘Taken together, these measures add up to the most significant public health intervention in a generation, a giant leap in this government’s mission to build a healthy society, and in doing so, helping to build a more healthy society too.’
The dental profession reacts to the smoking ban
Chloe Sharpe, dental therapist
Whether it will be effective, only time will tell, but it is time we take action against [smoking]. Smoking is a leading cause of cancer and is absolutely preventable. The negative effects smoking has on the body include an increased risk of cancer, heart disease and diabetes, and the taxpayer’s money is spent to cover the medical costs of these individuals.
What I am most concerned about is how easily accessible vaping has become to children under 18. No one seems to question the effects this is having on their health while they are still developing. Working at Eilertsen Dental Care in Plymouth, I see adults and teenagers who smoke or vape and have severe periodontal disease, dental decay and poor oral health.
Gemma Cowen, dental therapist
Reflecting on the ban on smoking implemented in 2007, the mere thought of reverting back to those days is unsettling. The effectiveness of such measures cannot be overstated.
Recently, there has been encouraging news regarding the sale of tobacco products. As a mother, I wholeheartedly endorse this change, recognising its potential to shield not only my own children but countless others from the grip of this highly addictive substance.
My childhood memories are tainted with images of sitting amidst a haze of smoke, attempting to find solace in the depths of a couch. Such experiences underscore the urgency of this action.
In my professional capacity, I witness firsthand the devastating impact of tobacco on oral health. Patients grapple with addiction, struggling to break free for the betterment of their oral and systemic wellbeing.
This initiative promises to safeguard future generations from the chains of addiction and the onslaught of systemic diseases. Moreover, it stands as a bulwark against the strain tobacco-related illnesses place on our healthcare system.
UK disposable vape ban – key facts
Disposable vapes will be banned in England and Wales from June this year in an effort to protect children’s health and reduce environmental harm.
This comes as research found that an estimated five million single-use vapes are either littered or thrown away in general waste each week in the UK, with a fourfold increase in just a year.
‘Devastating impact’
On announcing Northern Ireland ban delay, environment minister Andrew Muir said: ‘The environmental damage created by the rise in the littering and incorrect disposal of used vapes, as well as their poor recyclability, is a key concern for me.
‘Single-use vape waste can have a devastating impact on our environment and biodiversity and I welcome this ban which will have better benefits for our environment and consequently for our general health and wellbeing.’
He added: ‘My department, UK government, Scottish and Welsh governments have committed to separately developing legislation to ban single use vapes, with an agreed UK wide ban coming into operation from 1 June 2025.’
The ban – which will make it illegal to sell single-use vapes – was first announced in January 2024 by the previous government, but it was not brought into force before the general election.
Health minister Andrew Gwynne said: ‘It’s deeply worrying that a quarter of 11- to 15-year-olds used a vape last year and we know disposables are the product of choice for the majority of kids vaping today. Banning disposable vapes will not only protect the environment, but importantly reduce the appeal of vapes to children and keep them out of the hands of vulnerable young people.’
Ban fears
When government ministers first started preparing a ban on disposable vapes, Scott Butler, the executive director at Material Focus, said the ‘problem with single-use vapes has gotten further out of control’ over the previous 12 months. He added that ‘single-use vapes are a strong contender for being the most environmentally wasteful, damaging and dangerous consumer product ever made’.
However, he also expressed concern that a ban would lead to a surge of ‘hard to control illegal sales and an established illegal vape market’.
These fears were echoed by John Dunne, director general of the UK Vaping Industry Association, who stated that a ban is ‘not the answer’. He also argued that it would lead to black market, ‘putting smokers and vapers at significantly more risk of harm across the world.’
He also added that vaping products have proven to be ‘highly effective’ for smokers attempting to quit their habits.
